Underground: The Youth Culture of Steroids

Steve Brisbois' children know the dangers and even the telltale signs of steroid use — muscles that look abnormally large and are as hard as rocks and skin that seems unnatural and pulled over an unusual body structure. Years of their father pointing out steroid users taught them how to tell the difference between the natural muscles on the beach and the rippling, steroid-injected physiques.

And the former Arnold Classic competitor and 1986 Mr. Universe would know about steroids — he's an admitted former user. The 43-year-old isn't proud that like most other competing bodybuilders he used steroids during certain times in his career. He's not proud of the night in the early 1990s when a friend and fellow competitor died just down the corridor from Brisbois' room after a bodybuilding competition. Although postmortems say his friend's death was due to diuretics, Brisbois thinks otherwise.

Here's what he is proud of — that after his friend's death he quit bodybuilding and that he now has the opportunity to sit down his two daughters, ages 12 and 18, and three sons, ages 6, 8 and 10, and talk to them about steroids.

“They know the dangers,” he says. “You can only say so much as a parent, but they know me. They know that I can tell.”

But not every parent talks to his or her children about steroids. Unfortunately, unless you're in the bodybuilding, drug abuse or drug research business, you probably can't identify steroid users without some training. Although steroids have been around for years and illegal without a prescription since the Anabolic Steroid Control Act of 1990, a lot of parents still don't know much about them and wouldn't dream that their children — male, female, athletes and non-athletes alike — are using them.

“The general public equates anabolic steroids with sports, but that's what gathers headlines. That's the tip of the iceberg,” says Dr. Gary Wadler, member of the Prohibited List and Methods of the World Anti-Doping Agency. “The fact that young people are using them and girls are using them is very disconcerting. Anabolic steroids are very dangerous substances.”

Parents aren't the only ones in denial about steroid use. Although most coaches and athletic trainers know the signs of steroid use, they don't always see their players with an objective eye.

“The problem is that most coaches don't believe there's a problem at their school,” says Dr. Linn Goldberg, head of the sports medicine division at the Oregon Health and Science University. “They believe there are problems at other schools, but not theirs.”

There's little doubt though that steroid use is a problem. According to recent trend data tracked by the Risk Behavior Surveillance System at the Centers for Disease Control and Prevention (CDC), 6.1 percent of students in grades nine through 12 admitted to taking steroid pills or shots without a doctor's prescription one or more times. The data, which was collected from 1999 to 2003, showed a substantial increase from the 3.7 percent reported in 1999.

Despite the risks and dangers associated with steroid use — sudden death, changes in blood cholesterol, liver tumors, tendon injuries, severe acne and emotional disturbances are just a few of them — many teens, and even preteens, think steroids' perceived benefits outweigh any of the “potential” risks.

In 2004, about 56 percent of 12th grade students surveyed in the National Institute on Drug Abuse's (NIDA) Monitoring the Future Survey thought that steroids were of “great risk” if used once or twice. That's a 13 percent drop from 1998.

“Most of the outward or visible effects [of steroid use] are positive,” says Dr. Robert Kersey, director of the Athletic Training and Education Program at California State University, Fullerton. He explains that users often get compliments about being big, strong and muscular.

“That's a huge ego thing for them. They don't see their cholesterol. They just see that they're getting more dates.”

A Muscle Obsession

Many experts believe that a combination of issues is contributing to teen's increased use of steroids. Everything from societal pressures to be ripped to simply a teenager's likelihood to rebel coupled with feelings of invincibility can push a regular teen into a steroid-using mindset. Others, especially younger males and male athletes, are typically already risk takers and may be drawn to the drug more than their peers, Goldberg says.

“With an athlete mentality they're of the mindset that if a little is good then a lot is better,” says Tom Ciola, author of Steroids Kill!.

Mix that thinking with an athlete's desire or pressure from coaches, parents and others to get a scholarship or go pro, and you've got one dangerous combination.

“I can imagine that someone that was trying to get heavier or change their appearance to be more muscular or to obtain a scholarship might consider [using steroids],” says Dennis Helwig, athletic trainer for the University of Wisconsin-Madison. “Certainly though they can do it without.”

Society's acceptance and almost encouragement of steroid use is particularly troubling to many experts. For example, the slang term “on steroids” or “on 'roids” has taken on a cultural meaning of its own with numerous references in popular culture. Advertisers have picked up on the term to market everything from the Post-it Easel to U.S. Satellite Broadcasting's digital picture and sound to cross-trainers. Even Saab compared one of its vehicle's engines to the large muscles derived from steroid use in its campaign, Saab vs. Steroids (see photo on p. 26).

“Could anyone imagine a marketing strategy that makes the analogy that their product is ‘on’ any other drug of abuse, such as cocaine, LSD or marijuana?” Goldberg said in testimony on steroids to the U.S. House of Representatives in March. “In our society, only steroid drugs are associated with being bigger and better and used in ad campaigns.”

The rise in use may also mirror America's take-a-pill mentality. Users don't ponder their decision to use steroids because immediate gratification is expected in many facets of everyday life, Kersey says.

“To take a pill has become the standard. You're hurt — you take a pill. You're depressed — you take a pill. You want to look like that — you take a pill. There are shortcuts, but you're going to pay a price,” he says.

In and Out of Play

Most recent reports of steroid abuse in high schools have focused on athletes' use — high school sports teams in Arizona, Texas and Connecticut recently have admitted to use. Six students in Connecticut, three of whom played for the school's state-winning football team, were arrested for steroid use and distribution. However, the problem doesn't end with just athletes. In fact, more non-athletes may be taking steroids than athletes just because there are a larger number of those who don't participate in sports, Kersey says.

While steroid use is typically higher in males — especially those who play competitive sports — girls are overtaking that spot in the statistics. In fact, the largest growing group of high school steroid users is ninth-grade girls. According to the CDC, 7.3 percent have taken steroid pills or shots without a prescription compared to 6.9 percent of ninth-grade boys. The numbers are a bit lower for 10th-grade girls at 5.1 percent, and even lower in 11th and 12th graders at 4.3 percent and 3.3 percent, respectively (to compare those percentages with males see chart on p. 27).

Goldberg hypothesizes that the higher use by girls may be because steroids are body-shaping drugs often linked to diet pills, laxatives and diuretics. A cultural shift in what constitutes an attractive female body also has led girls away from the super-thin model look to a strong, athletic look, says Wadler.

“In recent years the new look is a muscular, defined, cut, six-pack abs look,” he says. “We can see it in how women are dressing — people are showing off their muscularity.”

Non-athletic boys aren't immune to societal pressures either. Experts have noticed an increasing number of users who are simply obsessed with looking better by getting bigger — a disorder called bigorexia. Although both females and males can have it, the disorder is more common in males. Like anorexia, those afflicted are obsessed with their appearance. Unlike anorexia, those with bigorexia are fixated on becoming as well-built and large as possible.

“There are some common themes [between anorexia and bigorexia],” Wadler says. “In both cases you're not satisfied with the appearance of your body. Individuals in both disorders manipulate their diet and exercise and use drugs and medications as they relentlessly try to get bigger or thinner. Both of them are obsessed with looking in mirrors.”

Although no hard numbers are available on how many suffer from bigorexia, Wadler cautions that most people are usually somewhere along the spectrum of the extremes of being too thin or too big. Most users just want to look better and are experimenting, he says.

Teens don't have to go far to find the drugs. Steroids come from across the Mexican border, the Internet and local health clubs, Kersey says.

“Dealers find their mark and are persistent in their insistence that drugs will provide the promised benefits,” he says.

Occasionally, it's not just young people buying steroids — it's their parents. Helwig has heard of some people obtaining a veterinary grade of steroids that are not made for humans and are dangerous. And, Ciola tells the story of a doctor who was approached by a set of overzealous parents demanding a prescription for steroids for their child. They were outraged when he refused.

Regardless of how the drugs are obtained, what may start as taking a pill or two can soon become a set of injections and cycles that are sped up. Kersey says users get wrapped in the drug culture after seeing positive results.

“A high percentage of users are multiple drug users,” he says. “They'll do orals to start and then injectibles. Then they get side effects so they take another drug to counteract the steroids.”

What's even scarier is that unlike some of steroid's temporary side effects on males (once they get off the steroids), masculinizing effects in females are permanent, Goldberg says. Because girls are throwing their hormonal balance off, the dangers are higher for females, Ciola says. In young users, the likelihood that steroids will prematurely stop their growth is still up in the air, but Dr. Jay Hoffman, vice president of the National Strength and Conditioning Association, says it's definitely a concern for both sexes.

Cracking Down?

So, with 800,000 high school students using or having used steroids, exactly what are schools doing to prevent abuse? Some state legislators are debating mandatory drug testing for athletes, some school districts are beefing up their educational efforts and others are doing nothing.

“These schools need guidance,” Goldberg says. “Information will help, but it really needs to come from the enlightened school district, state legislature or governor's office before they do anything.”

Recently, the U.S. Supreme Court upheld public school districts' right to randomly test students for drugs, and a number of states are working on legislation to require drug testing for high school athletes — Florida, Connecticut, Minnesota and Michigan all have legislation pending. However, some of these efforts have been limited by budgetary restrictions, and some school districts complain that they are losing control over a local issue. One Texas lawmaker who called for testing athletes that make state playoffs and barring from play athletes who test positive, later settled for creating a steroid education program and commissioning a study to gauge drug use.

“Testing appeases the public,” Kersey says. “Drug testing should be done, but it has to be quality [testing]. When schools can't afford paper for their students, I'm not sure [steroid testing] is going to rate high when you're talking about a small percentage of [users].”

Testing, although expensive at about $100 per test, may help school administrators determine the depth of the problem in their districts, and may act as a deterrent. Wadler emphasizes that schools must have a detailed, formalized and written steroid program and policy that spells out the intent, type and timing of testing and the consequences of a positive test.

Drug testing by schools may be particularly important because the U.S. Drug Enforcement Administration (DEA) has bigger fish to fry.

“Are you going to get the cocaine smuggler or the steroid user?” Kersey says. “[The DEA] has limited resources, and they're not making a lot of drug raids on those big bodybuilding health clubs.”

Beefing Up Knowledge

While required drug testing is debated in state legislatures, experts agree that education is an essential part of steroid abuse prevention. Currently, the public gets steroid information from TV, the Internet and popular media — and from the big guy in the gym, Kersey says.

Looking to better educate students, Goldberg and his colleague Dr. Diane Elliot have had success with the NIDA-funded ATLAS (for young men) and ATHENA (for young women) programs. Both are team-centered programs taught by student-athletes and facilitated by a coach. Schools from 29 states and Puerto Rico have used the programs, which provide healthy sports nutrition and strength-training alternatives to using steroids. After going through the ATLAS program male students had a more than 50 percent reduction in new anabolic steroid use, and female students in the ATHENA program had a significant reduction in use of diet pills, new sport supplements, amphetamines and steroids (for tips on setting up a program see p. 25).

“The high school years represent a critical window of opportunity to prevent the use of steroids, alcohol and other drugs,” Goldberg says. “Schools need to do what they do best — educate. They need to educate coaches, parents and their athletes.”

Both the ATLAS and ATHENA programs have addressed more than just steroid use. The world of supplements and other ergogenic aids is a large and dizzying one, but teens are taking more and more of these unregulated drugs.

“Because supplements look so much like and are put on the same shelf as medications, I think most people think that supplements are tested for safety, are proven to be effective and that their ads are supervised,” Hoffman says. “They think that what's on the label is what's in the bottle.”

In fact, Hoffman says, supplements may be a bigger issue than steroids because when looking at total numbers, more people are using supplements. According to the Food and Drug Administration, between 1994 and 2004, the number of dietary supplements jumped from 4,000 to 29,000. Much of the industry's success is due to the 1994 passage of the Dietary Supplement Health and Education Act, which allows products derived from herbs and natural sources to be classified as food, not drugs.

Experts are also concerned about young people using a variety of substances from metabolic burners (such as the recently outlawed ephedrine), creatine, the illegal steroid-like substance “andro,” and other protein powders and amino acid blends. Goldberg says young people often overuse these substances.

Other risks involve the purity of the supplement, a factor that also creeps into the steroid market. Kersey says a handful of studies have shown that steroids bought on the Internet have turned out to not contain what they promise.

Growth hormones, which are currently undetectable, are another area of concern; however, experts say their high cost has deterred their use.

Regardless of what the future holds, experts agree that discussion is positive — especially if it brings additional funding.

“I think the dialogue is very important,” Helwig says. “You see, these things run in cycles. There's rampant steroid use for a while, then it's quieted down and then it's back in the news again. We forget about it for a while and don't address it like we could. We need to stay on it for health reasons and to make sure that we combat it.”

Brisbois knows that like any drug, the problem won't go away, but he hopes that others, especially his children, learn from his experience. Twelve years after retiring, he now owns a wine shop in Orlando, FL, and has remained steroid free.

“[Taking steroids] was a mistake, but I don't regret it,” Brisbois says. “To me it was a learning experience. That was the route I chose and that's what I wanted. I did what I had to do, but I feel lucky that I got out when I did.”

Steroid Testing: Mandatory in University Athletics

Testing university and college athletes for steroids is mandatory. The National Collegiate Athletic Association (NCAA) spends close to $4 million a year on its national drug-testing programs. Along with education, two drug tests are given to college athletes — one during NCAA championships and the other at random during the academic year. Besides steroids, tests look for a gamut of substances including diuretics, urine manipulators and other steroid precursors or masking agents.

Because there isn't much testing for steroids in high schools, college often is the first time many athletes are subject to testing or sanctions, says Dennis Helwig, athletic trainer for the University of Wisconsin-Madison. Steve Malchow, associate athletic director for communications for the University of Wisconsin-Madison, finds it scary that some athletes have already dabbled with steroids prior to playing university athletics.

“The phenomenon is frightening,” he says. “They all want the scholarship or next million-dollar contract.”

NCAA substance use surveys show a decrease in steroid use since testing began in 1990. In 1989, 9.7 percent of NCAA Division I football players reported using anabolic steroids. In 1993, 5 percent reported using. In 1997 that number was down to 2.2 percent, and slightly increased in 2001 to 3 percent. Results of the 2005 study will be available later this summer, according to the NCAA.

Today, the NCAA tests more than 10,000 athletes, including freshmen and transfers, in all sports. Athletes that test positive are withheld from competition for at least a year and lose one of their four years of collegiate eligibility. A second offense results in losing all remaining eligibility and being permanently banned from intercollegiate athletics competition. Due to privacy issues, athletes' names are not released to the public if a test comes back positive.

Along with testing, the University of Wisconsin-Madison does steroid education on a team-by-team basis, usually given by coaches. The message? When athletes use these types of substances, they're not being fair to themselves, their teammates or their competitors.

“The best way to go is through education, both in terms of the negative effects of steroid use — especially for younger athletes who are still maturing — and in terms of the ethical aspects of sports. That's a big thing,” Helwig says. “It's important for everyone to know that their success is related to their hard work and not something artificial. Statements from teachers and coaches can make a big impression.”

Despite testing for an array of drugs, some still say it's easy to get around a test, especially for an athlete who has determined that the benefits of steroid use outweight the risks of getting caught. However, the NCAA says its testing is top-notch at identifying even so-called designer steroids that many experts claim are created and modified so quickly that drug tests can hardly keep up.

The NCAA points to the UCLA Olympic Analytical Labs, where NCAA testing is conducted, that identified the latest designer steroid to hit the market, THG. The lab developed a testing protocol to aid in the detection of hard-to-identify anabolic steroids, according to a statement given to Congress in early March by Mary Wilfert, chief liaison of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.

Military Works to Combat Steroid Use

Police officers, firefighters and military personnel work long hours under stressful conditions doing work that requires physical strength. It's no wonder they are not immune to the lure of steroids.

“Steroid use is rampant in the military,” says Tom Ciola, author of Steroids Kill!. “I've gotten e-mails from guys on ships that are saying that the drugs are just flying. It's a problem with police and firemen also.”

However, most police departments and fire departments perform drug testing as do different branches of the military.

“Each of the services has been actively communicating to their soldiers, sailors, airmen and Marines the risks of using these substances,” a Defense Department (DOD) spokesperson says. “This message is consistently delivered by the Army Center for Substance Abuse. The Navy has released a program advisory to the fleet and an e-gram as well as announcing the new law that classifies andro as a controlled substance. The Air Force continues to follow and promote the current policy deterring steroid use.”

The Air Force has done random drug testing since 1998 and has had an average of eight positives per year, the lowest of all the services, according to Lt. Col. Christopher Robinson, program manager of the Air Force Alcohol Drug Abuse Prevention and Treatment and Drug Demand Reduction (DDR). Tests are given year round at the rate of about one test per service member per year.

Each Air Force base has a DDR program manager responsible for drug testing, outreach and prevention. Robinson says their strategy for combating steroid use isn't standardized; instead managers work with the community to get the message out. And because steroids are illegal, punishment can range from jail time to loss of rank or punitive discharge from the Air Force. For example, in early March, an Air Force Academy cadet was found guilty of smuggling steroids into the United States and distributing them to another cadet. The cadet was reprimanded and ordered to forfeit all pay and allowances. He was found not guilty on two other accounts — introducing steroids with the intent to distribute, and ingesting hallucinogenic mushrooms and huffing toxic vapors to get high. The more serious charges could have meant 66 years of confinement.

However, steroids may not be at the top of the military's list when it comes to drugs. According to a DOD spokesperson, in 2004, only 84 members of the Armed Forces were tested for steroids, and while steroids are a prohibited substance by law, “we mainly concern ourselves with testing for substances that are more mainstream and have a higher prevalence for use.”

Dr. Jay Hoffman, vice president of the National Strength and Conditioning Association, sees a place in the military though for some supplements, which enhance energy production, use or recovery. For example, a combination of ephedrine and caffeine can help keep pilots awake on long missions. However, with aids such as creatine, proper hydration can be an issue, as is “roid rage” in steroid users.

Hoffman believes that the rate of steroid use in the military is probably comparable to that in the general public, and agrees that the military should be concerned with recreational drugs that are more likely to affect performance. The same story is true for police officers — steroids are probably used at low rates, but ergogenic aids may be used more frequently.

Creating A Prevention Program

Separate the girls and boys. Their risk and protective factors differ, so don't pair them together.

Additional RESOURCES

Ask peers to lead the program. Teens listen to teens, and the venue should be a place where students work together and share common goals.

Make sure younger and older adults are present. This allows the more mature students to serve as role models.

Get a good teacher that the students respect both in and out of the classroom.

Other thoughts from our readers:

PERCENTAGE OF U.S. STUDENTS WHO TOOK STEROIDS WITHOUT A DOCTOR'S PRESCRIPTION ONE OR MORE TIMES

In May we asked Fitness Business Pro readers for their opinions on steroid use in schools, universities and by government service personnel. Here are some of the results:

83% said high schools should test their students for steroids.

68% said steroid use is on the rise among young non-athletes.

55% said more high school girls are using steroids.

70% said universities are adequately educating their athletes about steroids.

59% said steroid use is a problem in the military.

70% said steroid use is an issue for other government service personnel.

74% said dietary supplements should not be regulated by the FDA.

“The use of anabolic steroids has been a growing epidemic for more than 40 years, and it will continue to be a problem until schools and colleges across the country begin mandatory drug testing for all sports (both men and women), and until athletes who test positive are banned for life from further competition with no exceptions. “

“This problem is not a new one; it's just been ignored because nearly all of us know someone who is taking steroids, especially those of us that are in the fitness industry and are around athletics. Athletes, bodybuilders, competitive weightlifters and gym rats are just hoping that the publicity dies off and goes away.”

“Steroids have serious medical benefits for those that need them; however, they have been deemed evil by the media. None of the drugs, aside from the designer/boutique steroids, were created for performance enhancement, and the media has made them all despicable.”

Source: Results of a Web poll of 151 respondents and a survey of 35 respondents.